Poor Embryo Development. Maybe It's Him.
It takes an egg and sperm to make a baby. I hope this video motivates men to make the necessary changes that can help them reach their maximun fertility potential to support their partner in having a healthy baby.
If you have been diagnosed as unexplained infertility or you have experienced miscarriages or you had poor embryo development in an IVF cycle where your embryos did not grow out to day 5, then it may not actually be unexplained, it could be him.
Men's reproductive health is easier to improve than female fertility, if only men would come in for treatment. I recommend the KISS for Men Program at Acublance Vancouver.
Video: Poor Embryo Development. Maybe It's Him.
Dr Paul Turek, reproductive urologist, shares how poor embryo development can be related to the guy in many casess. And how diet, lifestyle and a good antioxidant supplement can help with sperm DNA fragmentation. Find out why all roads to fertility lead to Chinese medicine.
We have sourced out a simple and effective antioxidant program for men available at Acubalance Vancouver.. Ask us about our KISS for Men.
Poor Embryo Development. Maybe It's Him.
If the woman is over 40, the IVF clinics will focus on the female and if she’s really young then maybe they will say that it could be him…but does the man contribute to the IVF failure rate? Dr Paul Turek gives his expert option during this interview with Dr Lorne Brown.
Dr Lorne Brown - Hi, my name is Lorne Brown, I'm a doctor of traditional Chinese medicine and I practice in Vancouver, British Columbia, Canada. And today we have our special guest, Dr. Paul Turek and many of you actually know Dr. Turek, a reproductive urologist practicing out of California. He has spoken at the Integrative Fertility Symposium all years, so you know, if we have a little pop quiz at the Integrative Fertility Symposium asking which speakers have been at every Integrative Fertility Symposium, here's a free giveaway if you're watching this, Paul Turek is one of those people. Maybe we'll give you a prize if you get that answer right. And he travels and speaks internationally at Western medicine conferences and integrative conferences like the Integrative Fertility Symposium, and we've interviewed him before on our web series and we have him back because he has new information. So, Dr. Turek, welcome.
Dr. Paul Turek - Absolutely. Thank you, Lorne. Did you know I'm also a faculty member at Yo San University?
Dr Lorne Brown - And see, look at this. He's done Western research, he's faculty on Chinese medicine, this is what I call doctor 3.0. This is true integration happening here and we appreciate this, Dr. Turek. And what I love about when we talk is you take Western medicine concepts and you distill it down for us that are practicing naturopathy, Chinese medicine, so we can take this information and share it with our patients. And you know what I really love is, you're so current and on top of the trends and what's happening here in reproductive health for men, and a lot of people don't get that when they go to their IVF clinic. Usually it's all about the female and they ignore the male. And you keep bringing it back to, hey, the guy matters. He's part of the equation, correct?
Dr. Paul Turek - Absolutely.
Dr Lorne Brown - You know in our practice we find we see a lot of the women and even if it's male factor we're not seeing the guys, and I just want to know from your experience kind of how much involvement is the man responsible for an unsuccessful IVF? Because it seems like if the woman's over 40, they blame it on the female. And if she's really, really young then maybe they'll say it could be him. I want to know, does the guy contribute to the IVF's failure rate? What's your opinion on this and let's talk more about what's his involvement, including evaluation.
Dr. Paul Turek - I would say the answer to that question of male factor involvement in failed IVF is a moving target. So, we used to think that, say 10 years ago, that once the sperm fertilizes the egg, the rest is egg driven. So, then we learned that you can fertilize an egg with a piece of dust, so that's not really that essential, but the first couple days is where the male gamete contributes to the first pronuclear division. So, the microtubule assembly, all that stuff. So, there's some obvious things going on. If you get a good fertilization rate, sperm have done most of what they're required to do and the rest of embryo development in a dish is probably egg driven. So, we thought maybe five percent would be male. And you can pick those cases maybe of sperm without acrosomes or double polyploid sperm, globozoospermia, lollipop sperm. That might fail. And then fragmentation came out, DNA fragmentation, and that opened up a little more. Because your sperm can look fine but when the DNA payload is dropped off and then undressed by the egg, it can come up fragmented. So that explained why smokers and others might have lower rates of fertilization et cetera. So DNA fragmentation, however, does not affect fertilization. So that's an independent process. It's only going to kick in when the genomes meet after first pronuclear fertilization. So that's really something going on between say day one and three, day one and four. Maybe more like day two to four. Early embryo development. And all of a sudden, and we don't know the percent there, but if you have a high DNA fragmentation rate, you're going to get poor embryo development. And that's a pretty big deal and that's hard to predict 'cause it's not based on a semen analysis and things like that. So that also agrees with the data on men taking prenatal supplements, so pre-pregnancy pills for men. We've had one out for seven years, and I'll just make a quick pitch, it was called Essential Beginnings. It's out of business. So we ran it out of the office, high quality organic product, and got some Pete's coffee money. And now it's coming out as AlphaSperm later this month, alphasperm.com, reformulated. But we started making that because of the data from randomized trials showing that men who took a prenatal, it was not specific, versus men who didn't. Their partners went through IVF. The pregnancy rate and miscarriage rates were higher and lower significantly compared to couples who didn't. The data wasn't great because trials weren't big, but the Cochrane review came out in 2011, 2013. Both of them said based on the data we have it's sort of like a two to threefold higher chance of pregnancy and less chance of miscarriage. And I think that's probably a DNA fragmentation issue.
Dr Lorne Brown - This is if they're taking a prenatal loaded with antioxidants, that's what we're--
Dr. Paul Turek - Right.
Dr Lorne Brown - So in your practice when the couple comes in, are you still encouraging... because the woman's always the folic acid, the prenatal CoQ10. You're encouraging men still to do vitamin therapy?
Dr. Paul Turek - More than ever, and I think everyone's doing it now because it's low-hanging fruit, right? Especially if they're smokers or if there's other risks, it's low-hanging fruit. And it may not help a lot, but women may not need that much help. It may be, you know, it's binary. If he's jumping just under the bar and he goes over the bar, boom, it happens. It's the executive decision in embryo development is proceed. So I think it's all coming together that way, and I'd say put it up to maybe 25% of the time. And then more recently, epigenetics came out. And the field of epigenetics is also very different from the others. And then the Utah Group did a study in Fert and Stert where they looked at the IVF outcomes of couples in whom there were no female factors and the sperm counts were normal. And they went through IVF, and the couples were segregated into good quality embryos or poor quality embryos. So no female factor, normal semen analysis, so this is unexplained. Unexplained infertility IVF. And if 80% of the embryos were terrible, they were in one group. If less than that or good, then they were in another group. The epigenetic patterns in the sperm in the abnormal group were horrible compared to the guys with the good embryo development. So you're probably looking at another 25% and that's a whole different field. And unfortunately the epigenetic testing for that, which was offered by Episona, is now not available because the company went under. They went bankrupt, did not go bankrupt but it lost its funding and it never took off. So it's the perfect thing at the wrong time, or too early for it to make it. So it didn't have enough traction, and one of the reasons it didn't have traction is people said, "Well what do we do with that information? "So you're telling me my sperm is damned going in, "but what can I do about it?" And that takes more time, but honestly, diet, exercise, overall health, and this is why I say the best thing you can do for your reproductive health is overall health and it's why I say that the more we know about genomics and epigenomics, what's become more important is lifestyle, health, stress reduction. All the things that Eastern medicine does so much better than Western medicine.
Dr Lorne Brown - All paths lead to Eastern medicine. You know, our conference for 2019, which you're speaking at, our theme is west meets east. We usually call it east meets west, but it's actually west meets east because I've been in practice since 2000 and usually they're saying, "Oh don't take vitamins. "You're wasting your money. "The stress-reduction meditation, it doesn't work. "The diet, who cares." And I remember, I think it was the 2016 conference, you were sitting there listening to the lectures and you turn to me and go, "I get it, I get what you're doing. "You guys are all about epigenetics. "This is so cool." Right? And I love that this whole west meets east and so it's nice that the science is starting to confirm and reaffirm how we practice. Because in Chinese medicine and naturopathy, there's interventions. You know, supplements, herbs, and acupuncture, but the crux of the medicine is diet, lifestyle, sleep, stress-reduction, right? There is no herb or supplement or anything that can override good lifestyle practices.
Dr. Paul Turek - No, no, right. And that's pretty clear and the other point was that in my edge of this field, and I'm not the first one in it, and I'm like, why can't we explain a lot of what's going on here? And then genetics, the genome project comes out. And then there's a bunch of genes and we still don't have a lot of explanations. Oh, they have a Y-chromosome, we have 20 to 30, but like it's disappointing. Because I thought, well what could it be? And then epigenetics comes out and all of a sudden, it's like, it's the Holy Grail. It really is. It's going to explain much of it. So, I think at this point we're at about half, I would say conservatively that half of failed IVF, especially poor embryo development, I call it dissolving embryo syndrome, is male factor. And I think every guy, I mean I started an evaluation called Maybe it's Him, and the concept was you fail IVF, and no one's looked at the guy and maybe it's him, and the chances are pretty good. I mean you could go to Reno and bet on it. But I think there's a tailored evaluation for these men that I offer, which starts at the semen analysis but goes deep very quickly into everything. Lifestyle, health, diet, and DNA fragmentation, and epigenetics if needed et cetera.
Dr Lorne Brown - So you said something that I think some of the listeners may miss. When you see these failed IVF cycles, the man obviously has had a semen analysis but they say it's normal, and you're saying maybe it's him, where you take the semen analysis and you go deeper and you start to look at these other factors that could be contributing that you're not going to see in a semen analysis, as well as DNA fragmentation and if necessary some of the epigenetic testing. So you're going to do a much deeper--
Dr. Paul Turek - Dive.
Dr Lorne Brown - I call it the health audit, the fertility audit. I used to be a CPA, so I say when they come in they say, "My semen analysis was normal." And I say well do you want to be normal or fertile? Right, we're going to dig, right? Who wants to be normal? The normal person is pre-diabetic or diabetic and overweight, I don't want to be regular. I want to be outstanding. So, let's look for it, let's dig a bit. And it seems like that's what your evaluation does, what you call Maybe it's Him. You're digging a little deeper.
Dr. Paul Turek - Yeah, and it's not just sperm. I mean, most people think that the male evaluation is semen analysis, at least most gynecologists, and they assume that a normal semen analysis means fertile. And you can't ever assume that anymore because these things are much different and so a formal evaluation is a history and a physical and a semen analysis and potentially bloodwork or other testing. And if you ask me what's the most important, I'd say the history and physical are probably the most important, and certainly lifestyle has become top. And now we're starting to explain all the things that weren't explainable when I was growing up in the field, and it's very satisfying. I would say today I saw seven new patients. Low counts, no counts, normal counts, and I could explain the problem in 80 to 85% of them. And my goal now when I see patients who have low sperm counts is figure it out. Figure it out. And I tell them, I'm going to tell you your story. That's my goal today, is tell you your story. What happened? How did it happen? What caused it? And then you can figure out what to do about it after, but I think of every patient as a story.
Dr Lorne Brown - And we call this looking for the underlying cause and you're like finding the story, so we're going to find out what's going on and then we can explain it. I love this. The narrative, the story behind why they're having failed IVFs or infertility.
Dr. Paul Turek - Instead of assuming that you don't know, assume that you can figure it out. And it's somewhere in the information that you have because that's what it looks like. It looks like it's in the history and physical and elsewhere.